Hyperuricemia May Affect the Healing of Anastomosis in Dixon Surgery for Rectal Cancer: A Retrospective Study

2021 ◽  
Author(s):  
Xue-Cong Zheng ◽  
Jin-Bo Su
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Measurement Data ◽  
Preoperative Chemoradiotherapy ◽  
Anal Margin ◽  
Logistic Analysis ◽  
Cancer Group ◽  
Intervention Measures ◽  
Significant Difference ◽  
The Impact

Abstract Background：The impact of Hyperuricemia (HUA) on Dixon surgery is rarely reported. Anastomotic leakage (AL) is the main serious complication in Dixon surgery. We discussed the relationship between HUA and AL. Our aim was to identify these factors to provide intervention measures for clinical practice.Methods：The clinical data of 1147 patients who underwent Dixon operation for rectal cancer in the Second Affiliated Hospital of Fujian Medical University from January 2009 to December 2018 were retrospectively analyzed. Rank sum test was used for measurement data, and χ2 test was used for counting data. In univariate analysis, significant variables (P < 0.05) were used for multivariate analysis, and multivariable logistic regression was used to examine their independent roles. All tests were 2-sided, P<0.05 was considered statistically significant.Results：A total of 1147 patients with rectal cancer undergoing Dixon operation were included in the study, including 153 patients with HUA and 994 patients with normal uric acid (UA). The AL was 148 cases (14.9%) in UA group and 37 cases (24.2%) in HUA group. There was significant difference in AL (P = 0.006). The influence of HUA (P = 0.006), Tumor distance from the anal margin (TD) (P = 0.024) and preoperative chemoradiotherapy (PCT) (P = 0.040) on AL were significantly different. Logistic analysis showed that HUA (P = 0.021) and TD (P = 0.014) had significant effects on AL. In rectal cancer group with HUA, there were significant differences in the effects of male (P = 0.035), body mass index (BMI) (P = 0.017) and PCT (P = 0.013) on AL. Logistic analysis showed that there were significant differences between male (P = 0.001) and PCT (P = 0.004) on AL.Conclusions：HUA is an independent risk factor of AL in Dixon operation for rectal cancer. In patients with HUA undergoing Dixon operation, gender, BMI and PCT have significant difference on AL. Male and PCT are independent risk factors of AL.

The influence of treatment response on the impact of resection margin status after preoperative chemoradiotherapy in rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 505-505 ◽  
Author(s):  
Eui Kyu Chie ◽  
Jooho Lee ◽  
Kyubo Kim ◽  
Seung-Yong Jeong ◽  
Kyu Joo Park ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Treatment Response ◽  
Clinical Outcomes ◽  
Resection Margin ◽  
Preoperative Chemoradiotherapy ◽  
Postoperative Treatment ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Significant Difference ◽  
The Impact

505 Background: Circumferential resection margin (CRM) and distal resection margin (DRM) have different impact on clinical outcomes after preoperative chemoradiotherapy (CRT) followed by surgery. Effect and adequate length of resection margin as well as impact of treatment response after preoperative CRT was evaluated. Methods: Total of 403 patients with locally advanced rectal cancer underwent preoperative CRT followed by total mesorectal excision between January 2004 and December 2010. After applying the criterion of margin less than 0.5 cm for CRM and/or less than 1 cm for DRM, 158 cases were included as a study cohort. All patients underwent conventionally fractionated radiation with dose over 50 Gy and concurrent chemotherapy with 5-FU or capecitabine. Median follow-up duration was 44.9 months. Results: The 5-year overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were 83.3%, 75.6%, 86.3%, and 77.4% respectively. CRM of 1.5 mm and DRM of 7 mm were cutting points showing maximal difference using maximal chi-square method. In univariate analysis, the shorter CRM was significantly related with worse clinical outcomes, whereas DRM was not. In multivariate analysis, CRM of 1.5mm, ypN, and perineural invasion were prognosticators for OS, DFS, LRFS, and DMFS. CRM was not a significant prognostic factor for good responders, defined as patients with near total regression or T down-staging. However, poor responders demonstrated a significant difference according to the CRM status. Conclusions: Close CRM, defined as 1.5 mm, was a significant prognosticator, but the impact was different for treatment response. Postoperative treatment strategy may be individualized based on this finding. However, findings from this study needs to be validated with larger independent cohort. [Table: see text]

Risk of Bioaerosol Contamination With Aspergillus Species Before and After Cleaning in Rooms Filtered With High-Efficiency Particulate Air Filters That House Patients With Hematologic Malignancy

2007 ◽  
Vol 28 (9) ◽  
pp. 1066-1070 ◽  
Author(s):  
Linda D. Lee ◽  
Matthew Berkheiser ◽  
Ying Jiang ◽  
Brenda Hackett ◽  
Ray Y. Hachem ◽  
...  
Keyword(s):  
High Efficiency ◽  
Hematologic Malignancy ◽  
Geometric Mean ◽  
Univariate Analysis ◽  
Patient Discharge ◽  
Cancer Center ◽  
Logistic Analysis ◽  
Surface Samples ◽  
Significant Difference ◽  
The Impact

Objective.To examine the impact of cleaning and directional airflow on environmental contamination with Aspergillus species in hospital rooms filtered with high-efficiency particulate air (HEPA) filters that house patients with hematologic malignancy.Design.Detailed environmental assessment.Setting.A 475-bed tertiary cancer center in the southern United States.Methods.From April to October 2004, 1,258 surface samples and 627 bioaerosol samples were obtained from 74 HEPA-filtered rooms (in addition, 88 outdoor bioaerosol samples were obtained). Samples were collected from rooms cleaned within 1 hour after patient discharge and from rooms before cleaning. Positive and negative airflows were evaluated using air-current tubes at entrances to patient rooms.Results.Of 1,258 surface samples, 3.3% were positive for Aspergillus species. Univariate analysis showed no relationship between cleaning status and occurrence of Aspergillus species. Of 627 bioaerosol samples, 7.3% were positive for Aspergillus species. Multiple logistic analysis revealed independently significant associations with detection of Aspergillus species. Cleaned rooms positive for Aspergillus species had a higher geometric mean density of colonies than that of rooms sampled before cleaning (18.9 vs 5.5 colony-forming units [cfu] per cubic meter; P = .0047). Rooms with positive airflow had a detection rate for bioaerosol samples equivalent to that of rooms with negative airflow (7.3% vs 7.8%; P = .8). There was no significant difference in the density of Aspergillus species between rooms with negative airflow and rooms with positive airflow (12.5 vs 8.4 cfu/m3; P = .33).Conclusions.Concentration of bioaerosol contamination with Aspergillus species was increased in rooms sampled 1 hour after cleaning compared with rooms sampled before cleaning, suggesting a possible correlation between reentrained bioaerosols (ie, those suspended by activity in the room) after cleaning and the risk of nosocomial invasive aspergillosis.

scholarly journals AB0132 THE STUDY OF SUBCLINICAL SYNOVITIS DETECTED BY ULTRASONOGRAPHY AND MRI IN RA PATIENTS AFTER REACHING CLINICAL REMISSION ON PATIENT’S SUBJECTIVE SYMPTOMS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1094.2-1094
Author(s):  
M. Nawata ◽  
K. Someya ◽  
T. Aritomi ◽  
M. Funada ◽  
K. Nakamura ◽  
...  
Keyword(s):  
Clinical Remission ◽  
Research Funding ◽  
Morning Stiffness ◽  
Univariate Analysis ◽  
P Value ◽  
Research Support ◽  
Residual Symptoms ◽  
Logistic Analysis ◽  
Significant Difference ◽  
Multivariate Logistic Analysis

Background:The goal of treatment in rheumatoid arthritis (RA) is to achieve remission. There is the patient with residual symptoms in the Japanese RA patient who achieved clinical remission. There are not many studies to examine the relation between everyday life, social activity and evaluation of disease activities using high-sensitivity image examinations (musculoskeletal ultrasound (MSKUS) and MRI).Objectives:To examine the relationship between subjective residual symptoms and imaging examinations in RA patients who have achieved clinical remission.Methods:30 RA patients who achieved SDAI remission during RA treatment. Age, sex, disease duration, physical findings, serological markers, disease activity, HAQ, EQ-5D-5L, FACIT-F, Patient Reported Outcomes (PROs), EGA and medications were evaluated. 44 joints were assessed by MSKUS with gray scale (GS) and power doppler (PD) and contrast-enhanced bilateral joint MRI scoring with OMERACT-RAMRIS scoring.Results:1. The mean SDAI of the 30 RA patients was 1.3. 2.In the analysis of the presence or absence of subjective residual symptoms that led to remission of SDAI (Table 1).Table 1.Subjective residual symptoms/presence (N=17)Subjective residual symptoms/absence (N=13)Univariate analysisp valueMultivariate logistic analysisp valueTJC0.0±0.00.3±0.50.0173HAQ0.4±0.40.05±0.10.00950.00181EQ5D-5L0.8±0.10.9±0.00.0001FACIT-F14.5±9.84.6±4.30.0233Morning stiffness (min)256.5±564.80.0±0.00.0210Pain (VAS) (mm)9.2±9.50.9±1.50.00440.0455PGA (mm)7.7±9.00.5±1.10.0013(1). In the univariate analysis, the number of tender joints, HAQ, EQ-5D-5L, FACIT-F, morning stiffness, and pain VAS were extracted with significant differences.(2). In multivariate logistic analysis, HAQ and pain VAS were extracted as independent factors with significant differences. 3.In univariate analysis of the association between HAQ and pain VAS extracted in multivariate logistic analysis and imaging examinations (MSKUS/MRI), MRI-synovitis was extracted with a significant difference in HAQ.Conclusion:1. It was suggested that Pain VAS and HAQ due to RA could be identified in patients reaching SDAI remission. 2. In patients reaching SDAI remission, Pain VAS ≤10 or HAQ ≤0.5 suggested that subjective residual symptoms may be eliminated. 3. HAQ ≤ 0.5 suggests that synovitis is less likely to be detected on MRI. 4. In patients who have reached SDAI remission, little residual inflammation was observed on US, suggesting that induction of remission is important not only to prevent joint destruction, but also to improve and maintain long-term QoL.Disclosure of Interests:MASAO NAWATA Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Kazuki Someya: None declared, Takafumi Aritomi: None declared, Masashi funada: None declared, Katsumi Nakamura: None declared, SAITO KAZUYOSHI Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Yoshiya Tanaka Speakers bureau: I have received speaking fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Consultant of: I have received consulting fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Grant/research support from: I have received research grants from Mitsubishi-Tanabe, Takeda, Chugai, Astellas, Eisai, Taisho-Toyama, Kyowa-Kirin, Abbvie, and Bristol-Myers

scholarly journals A Survey of Marine Coastal Litters around Zhoushan Island, China and Their Impacts

2021 ◽  
Vol 9 (2) ◽  
pp. 183
Author(s):  
Xuehua Ma ◽  
Yi Zhou ◽  
Luyi Yang ◽  
Jianfeng Tong
Keyword(s):  
Rapid Development ◽  
Univariate Analysis ◽  
Local Environment ◽  
Marine Litter ◽  
Social Ecological ◽  
The Social ◽  
Significant Difference ◽  
Valuable Method ◽  
Beach Litter ◽  
The Impact

Rapid development of the economy increased marine litter around Zhoushan Island. Social-ecological scenario studies can help to develop strategies to adapt to such change. To investigate the present situation of marine litter pollution, a stratified random sampling (StRS) method was applied to survey the distribution of marine coastal litters around Zhoushan Island. A univariate analysis of variance was conducted to access the amount of litter in different landforms that include mudflats, artificial and rocky beaches. In addition, two questionnaires were designed for local fishermen and tourists to provide social scenarios. The results showed that the distribution of litter in different landforms was significantly different, while the distribution of litter in different sampling points had no significant difference. The StRS survey showed to be a valuable method for giving a relative overview of beach litter around Zhoushan Island with less effort in a future survey. The questionnaire feedbacks helped to understand the source of marine litter and showed the impact on the local environment and economy. Based on the social-ecological scenarios, governance recommendations were provided in this paper.

scholarly journals POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 876-877
Author(s):  
W. Zhu ◽  
T. De Silva ◽  
L. Eades ◽  
S. Morton ◽  
S. Ayoub ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Univariate Analysis ◽  
Diagnostic Delay ◽  
Cohort Differences ◽  
Phone Calls ◽  
Retrospective Audit ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Background:Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.Objectives:To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.Methods:We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.Results:3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).Conclusion:Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.Disclosure of Interests:None declared.

scholarly journals USE OF A WASHER DOES NOT AFFECT THE RATE OF IMPLANT REMOVAL OR ELBOW MOTION AFTER FIXATION OF MEDIAL EPICONDYLE FRACTURES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Neeraj M. Patel ◽  
Christopher R. Gajewski ◽  
Anthony M. Ascoli ◽  
J. Todd Lawrence
Keyword(s):  
Screw Fixation ◽  
Univariate Analysis ◽  
Medial Epicondyle ◽  
Implant Removal ◽  
Hardware Removal ◽  
Rank Test ◽  
Retrospective Case ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

Background: The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). Methods: All surgically-treated pediatric medial epicondyle fractures over a 7-year period were queried for this retrospective case-control study. Patients were only included if their fracture was fixed with a single screw with or without a washer. Per institutional protocol, implants were not routinely removed after fracture healing. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Full ROM was considered flexion beyond 130 degrees and less than a 10-degree loss of extension. Univariate analysis was followed by creation of Kaplan-Meier (one minus survival) curves in order to analyze the time until full ROM was regained after surgery. Curves between patients with and without a washer were compared with a log rank test. Results: Of the 137 patients included in the study, the mean age was 12.2±2.3 years and 85 (62%) were male. A total of 31 (23%) patients ultimately underwent hardware removal. A washer was utilized in 90 (66%) cases overall. There was not an increased need for subsequent implant removal in these patients compared to those that underwent screw fixation alone (p=0.11). The mean BMI of patients that underwent hardware removal (19.1±2.5) was similar to that of children who did not (20.4±3.5, p=0.06). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (p=0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9±9.7 weeks after surgery (Figure 1). There was no statistically significant difference in the proportions of patients with and without a washer that achieved full ROM (p=0.46). Full ROM was achieved at a mean of 14.1±11.0 weeks in those with a washer compared to 13.6±6.2 weeks in those without one (p=0.21). Conclusions: Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of pediatric medial epicondyle fractures, even in thinner patients or competitive athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.

A New Cytokine-Based Stratification Is Highly Predictive of Survivals in AML Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1412-1412
Author(s):  
Pierre Peterlin ◽  
Joelle Gaschet ◽  
Thierry Guillaume ◽  
Alice Garnier ◽  
Marion Eveillard ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Risk Stratification ◽  
Univariate Analysis ◽  
Standard Of Care ◽  
Healthy Controls ◽  
First Line ◽  
Serum Samples ◽  
Gm Csf ◽  
Significant Difference ◽  
The Impact

Introduction: Recently, a significant impact of the kinetics of Fms-like tyrosine kinase 3 ligand concentration (FLc) during induction (day[D]1 to D22) has been reported on survivals in first-line acute myeloid leukemia (AML) patients (pts) (Peterlin et al, 2019). Three different FLc profiles were disclosed i) sustained increase of FLc (FLI group, good-risk), ii) increase from D1 to D15, then decrease at D22 (FLD group, intermediate-risk) and iii) stagnation of low levels (&lt;1000 pg/mL, FLL group, high-risk). An update of this prospective monocentric study (www.ClinicalTrials.gov NCT02693899) is presented here evaluating also retrospectively the impact on outcomes of 6 other cytokine level profiles during induction. Methods: Between 05/2016 and 01/2018, 62 AML pts at diagnosis (median age 59 yo [29-71], &lt;60 yo n=33) eligible for first intensive induction were included and provided informed consent. They received standard of care first-line chemotherapy. Serum samples collected on D1, 8, 15 & 22 of induction were frozen-stored until performing ELISA for FL, TNFa, SCF, IL-1b, IL-6, IL-10, GM-CSF. Normal values were assessed in 5 healthy controls. Pts outcomes considered were relapse/leukemia-free (LFS) and overall (OS) survivals. Results: FLI, FLD and FLL profiles were observed for 26, 22 and 14 pts respectively. A total of 372 samples were assayed for the 6 other cytokines. Median concentrations at D1, D8, D15, D22 for these 6 cytokines were as follows, considering the whole cohort (and healthy donors): TNFa: 0.53, 0, 0, 0 (0); SCF: 5.91, 0, 0, 0 (3); IL-1b : 0, 0, 0, 0 (0); IL-6: 4.85, 16.28, 10.11, 7.1 (0), IL-10: 0, 0, 0, 0 (0) and GM-CSF:1.63, 1.8, 0.67, 1.34 (9.98). Median IL-6 and GM-CSF levels, compared to healthy controls, were respectively higher and lower during induction. No significant difference was observed in terms of median cytokine concentrations at any time when comparing the three FL sub-groups or FLI vs FLD pts. With a median follow-up of 28 months (range: 17-37), FLI and FLD pts show now similar 2-y LFS (62.9% vs 59%, p=0.63) and OS (69.2% vs 63.6%, p=0.70). FLL pts have a significantly higher rate of relapse (85,7% vs FLI 19,2% vs FLD 32%, p=0,0001). Comparing FLL vs FLI+FLD pts disclosed significantly different LFS (7.1% vs 61.1%, p&lt;0.001) but not OS (36.7% vs 66.6%, p=0.11). In univariate analysis, 2y LFS and OS were not affected by the concentration (&lt; or &gt; median) of the 7 cytokines studied except for LFS and GM-CSFc at D8 (p=0,04) and D15 (p=0,08), for LFS and FLc at D1 (p=0.06), D8 (p=0,03), D15 (p=0,04) and D22 (p=0,03) and for OS and GM-CSF at D15 (p=0.08). A significant association between LFS was observed with ELN 2017 risk stratification (2-y LFS: favorable: 68,1% vs intermediate: 48,1% vs unfavorable: 30,7%, p=0.03) but not OS (2 y: 77% vs 55,5% vs 46,1%, p=0.09). Multivariate analysis showed that no factor was independently associated with OS while LFS remained significantly associated with the FLc profile (FLL vs others, HR: 5.79. 95%CI: 2.48-13.53, p&lt;0.0001) and GM-CSF at D15 (HR: 0.45; 95%CI: 0.20-0.98, p=0.04) but not with ELN 2017 risk stratification (p=0.06). Cytokine levels were then assessed to try to better discriminate FLI and FLD pts. A significant higher IL-6 level at D22 was found in relapsed or deceased FLI/FLD pts (median:15,34 vs 5,42 pg/mL, p=0,04). FLI/FLD pts with low IL-6 at D22 (&lt; median, 15.5 pg/mL, n=35 vs n=14 with high level) had significant better 2y LFS and OS (74,2% vs 38,4%, p=0,005 and 77,1% vs 38,4%, p=0,009, respectively). A new prognostic risk-stratification could thus be proposed, i.e. FLI/FLD with IL-6 &lt;15.5 pg/mL (favorable), FLI/FLD with IL-6 &gt;15.5 pg/mL (intermediate) and FLL (unfavorable). This new classification was considered for a second multivariate analysis, showing that it is the strongest factor associated with OS (p=0.006, ELN p=0.03, FL profile p=0.04) and LFS (p&lt;0.0001, ELN p=0.005, GM-CSFc D15 p=0.03) (figure 1). Conclusion: This study confirms stagnation of low FLc during AML induction as a strong poor prognosis factor. Moreover, IL-6 levels at D22 further discriminate FLI/FLD pts. Thus, a new cytokine-based risk-stratification integrating FL kinetics and IL-6 levels during induction may help to better predict outcomes in first-line AML patients. These results need to be validated on a larger cohort of AML patients while anti-IL-6 therapy should be tested in combination with standard 3+7 chemotherapy. Figure 1 Disclosures Peterlin: AbbVie Inc: Consultancy; Jazz Pharma: Consultancy; Daiichi-Sankyo: Consultancy; Astellas: Consultancy. Moreau:Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Celgene: Consultancy, Honoraria. Chevallier:Jazz Pharmaceuticals: Honoraria; Incyte: Consultancy, Honoraria; Daiichi Sankyo: Honoraria.

Revalidation of the Flipi Score in the Era of Immunotherapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4437-4437
Author(s):  
German Stemmelin ◽  
Carlos Doti ◽  
Claudia Shanley ◽  
Jose Ceresetto ◽  
Oscar Rabinovich ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Univariate Analysis ◽  
Risk Groups ◽  
Marrow Transplant ◽  
Intermediate Risk ◽  
Significant Difference ◽  
The Difference ◽  
The One ◽  
The Impact

Abstract The FLIPI prognosis score for follicular lymphoma (FL) was developed based on cases diagnosed between 1985 and 1992, and treated with different schemes that did not include rituximab (R). In the present study, we report the evolution of all FL treated in a single institution through the last decade and analize whether FLIPI mantains its effectiveness to identify different risk groups within patients treated with the new therapeutic alternatives available. Material and Methods: We identified sixty two patients with diagnosis of grade I-II-IIIa FL. Patients characteristics: median age 57.5 yr (r, 30–80); 36 males; 63% stages III–IV, and 37% with bone marrow infiltration at the time of diagnosis. Thirty eight percent had a low risk by FLIPI, 34% had an intermediate risk and 27.4% had a high risk. In 19 pts (30.6%) the initial decision was “watch and wait” but 82% received a form of treatment at some point. R was used in 36 pts (58%) with some of the following regimes: chemotherapy (chemo) + R and/or R as consolidation therapy and/or R as monotherapy and/or R as maintenance therapy. Of all prescribed treatments (excluding R as monotherapy and/or maintenance treatment), 52.8% were chemo alone, 20.2% chemo + R, 21.3% radiotherapy and 5.6% received a bone marrow transplant. Results: we considered the analysis of overall survival (OS) the most appropiate approach, since most treatments were seeking the control of the FL, and not the complete remission or cure. The follow up median time was 53.2 months ± 34.8 1SD. The 5-yr OS for the 62 pts was 81.8% ± 11.3 CI 95%. The 5-yr OS for those with a low, intermediate and high risk FLIPI was 100% −5, 84.2% ± 21 and 52% ±26.2, respectively. The difference in 5-yr OS was statistically significant between low and high risk, intermediate and high risk, but failed to prove a significant difference between low and intermediate risk. Among the different risk factors tested in a univariate analysis only age ≥ < 60 yr old demonstrated a significant difference, 60.7% vs 90%, respectively. Conclusions: The 5-yr OS in our series is higher than the one described in the original FLIPI study (Blood2004; 104:1258–65) which was 81.8% vs 71% for the whole group; 90% vs 78.1% for pts <60 yr old; 60.7% vs 57.7% for ≥ 60 yr old; 100% vs 90.6% for low FLIPI and 84.2% vs 77.6% for intermediate FLIPI. The only group that failed to prove an improvement was the high risk FLIPI with 52% vs 52.5%. The impact of novel therapies was more evident in patients with a low or intermediate FLIPI and was even more evident in patients younger than 60 yr old. According to our results, FLIPI maintains its effectiveness in differentiating two risk groups, i.e., low-intermediate vs high. We believe that the OS curves will probably continue to improve as the treatments that are considered today as the most effective ones, were just included in our series in the last three years.

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